NOTE: Excerpts are provided on dLife.com for informational purposes only. The information contained within will not be updated by dLife and may be outdated. Please consult your doctor before acting on anything described here.

Chapter 1.

Let's Get Acquainted

Let's be upfront. Either you forked down good money for this book, or somebody is making you read it. Either way, you've invested your time and/or money and deserve to get something good in return.

So, how do you know you can trust little-old-me to set you on the golden path to better diabetes management? I find that it helps to establish some common ground. For starters, I too find diabetes to be a royal pain in the butt (pain in the bum for those of you in EU and AU; pain in the tuchus for my Israeli friends). The whole idea of working at something year after year just so that nothing bad happens just doesn't sit well with me. And even after working at it, the results aren't always there. Why, for instance, can the same type of bagel from the same shop make my glucose go very high one day but not the next?

Like you, I have enough to do without all the added responsibilities of taking care of my diabetes. Doctor's visits, getting labwork and treating lows take time away that I'd much rather spend with my wife or kids. Checking blood glucose, counting carbs and calculating insulin doses are part of the "price" we all have to pay before eating just about anything. And speaking of price, I'd much rather spend my money on new clothes or tickets to a ballgame than on CGM sensors and pump supplies. Heck, managing diabetes is like having another entire job lopped on top of everything else in our lives – but without weekends off, and certainly without the moolah.

You may have also found, as I have, that today's healthcare system just isn't equipped to manage diabetes properly. And that goes for more than just the American system; virtually everyone I've consulted across the globe has had the same experience: healthcare providers consistently coming up short when it comes to time, expertise, and access. It's not from a lack of desire; most physicians are talented, motivated, caring people who wish they had the time and resources to do more for their patients. It's just that the demands placed on today's physicians (and their support staff) are so great that precious little time is available for teaching/helping us learn the finer points of living with diabetes. And this is true whether your clinician is part of a government-funded health program, a managed-care organization, or a private group of healthcare providers.

Hopefully, you're nodding your head by now, mumbling "Yea. He gets it." Well, here's a synopsis of my life with diabetes thus far. See if anything else sounds familiar.

My Story

It was two o'clock in the afternoon on a typically hot, muggy summer day in Sugarland, Texas, a suburb in southwest Houston. (No, I'm not making this up. The irony is just unbelievable.) After spending half the summer sucking down cold drinks and the other half peeing them out, I decided it was time to see the family doctor.

I hardly knew this doctor, but I had had about all I could take. My energy was gone, and there was no way the Houston summer could have caused me to lose so much weight (I had gone from 155 pounds to 117). I actually couldn't tighten my belt enough to keep my pants from falling down. Then I saw an episode of M*A*S*H in which a helicopter pilot had diabetes. And guess what – he had many of the same symptoms! So I decided it was time to get checked out.

It was only a 10-minute drive from my family's house to the doctor's office, so I was able to make it with just one pit stop to use a gas station restroom. (That summer, I learned where all the best public restrooms were along the I-59 corridor in southwest Houston.) When I got to the doctor's office, I put on my glasses (miraculously, I could suddenly see road signs without my glasses for the first time ever), wiped off the steam created by the 10,000% humidity, and prepared myself for the worst.

After a quick physical exam, blood test and urinalysis, the doctor came back in and said nonchalantly, "Gary, I've got good news and I've got bad news. The bad news is that you have diabetes, and you're going to have it for the rest of your life."

I have no idea what the good news was, because I stopped listening at that point. The first syllable from "diabetes" stuck in my head. What the heck is diabetes? About all I knew was that it was making my body wither away and that it wasn't going to go away until I died.

I remember him telling me that my blood sugar was 600 something, and that that was 6 times the normal level. I also remember him saying that I would have to take shots and be very careful of what I ate. The thought of giving myself shots was one thing. But limit what I eat? Was he crazy? I was an active 18-year-old with the metabolism of a small country. The very thought of not being able to eat whatever I wanted whenever I wanted made me more depressed than anything else.

So, off I went to an endocrinologist at a fancy high-rise in downtown Houston. Keep in mind that the year was 1985 and there were no HMOs yet, so getting in to see a specialist was as easy as making a phone call.

"You are lucky to be diagnosed now," explained the endocrinologist. "We have come a long way in the treatment of diabetes. I'll bet that in 5 or 10 years, your diabetes will be cured."

I should have taken that bet.

I then met with a nurse who taught me the "basics" about diabetes. I discovered what insulin is and why it is important. I learned a little bit about how food and exercise affect blood sugar levels, and what can happen if I don't keep mine under control. I also found out why the high blood sugars I had been experiencing all summer turned me into a human water fountain.

Finally, I was instructed on how to inject insulin. Forget about practicing on oranges, pillows, and teddy bears. I gave myself my very first injection, right in the stomach. It hurt—probably because I had almost no fat left on my body, and the syringe needles were much thicker and longer than they are today. But mostly it hurt because I was tense and overwhelmed at the thought of sticking needles in myself for the rest of my life.

by
Brenda Bell
Well maybe not so much a furor as a controversy. The question, bluntly put, is whether or not a single HbA1c reading should be sufficient and adequate to diagnose diabetes — and whether the conditions under which the test was conducted should have any bearing on the diagnostic or non-diagnostic value of the test. The lede from